<!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('新增病患管理')" />
</head>
<body class="white-bg">
    <div class="wrapper wrapper-content animated fadeInRight ibox-content">
        <form class="form-horizontal m" id="form-bs-add">
            <div class="form-group">    
                <label class="col-sm-3 control-label">病历号：</label>
                <div class="col-sm-8">
                    <input name="blnumber" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">主诉：</label>
                <div class="col-sm-8">
                    <input name="zs" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">主诉人：</label>
                <div class="col-sm-8">
                    <input name="zsr" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">行程史：</label>
                <div class="col-sm-8">
                    <input name="xcs" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">婚育史：</label>
                <div class="col-sm-8">
                    <input name="hys" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">家庭史：</label>
                <div class="col-sm-8">
                    <input name="jts" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">既往史：</label>
                <div class="col-sm-8">
                    <input name="jws" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">传染病史：</label>
                <div class="col-sm-8">
                    <input name="crbs" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">手术史：</label>
                <div class="col-sm-8">
                    <input name="sss" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">外伤史：</label>
                <div class="col-sm-8">
                    <input name="wss" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">输血史：</label>
                <div class="col-sm-8">
                    <input name="sxs" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">过敏史：</label>
                <div class="col-sm-8">
                    <input name="gms" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">预防接种史：</label>
                <div class="col-sm-8">
                    <input name="yfjzs" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">现病史：</label>
                <div class="col-sm-8">
                    <input name="xbs" class="form-control" type="text">
                </div>
            </div>
            <div class="form-group">    
                <label class="col-sm-3 control-label">备注：</label>
                <div class="col-sm-8">
                    <input name="remarks" class="form-control" type="text">
                </div>
            </div>
        </form>
    </div>
    <th:block th:include="include :: footer" />
    <script th:inline="javascript">
        var prefix = ctx + "system/bs"
        $("#form-bs-add").validate({
            focusCleanup: true
        });

        function submitHandler() {
            if ($.validate.form()) {
                $.operate.save(prefix + "/add", $('#form-bs-add').serialize());
            }
        }
    </script>
</body>
</html>